Laser methods and systems for addressing, mitigating and reversing presbyopia

ABSTRACT

Systems and methods for performing laser operations to improve the accommodative amplitude of an eye. Systems methods and laser delivery patterns and operation for structural pillars in the lens of the eye to permit deformation of laser effected areas of the lens that are adjacent to the pillars.

This application claims under 35 U.S.C. § 119(e)(1) the benefit of thefiling date of U.S. provisional application Ser. No. 62/637,452, filedMar. 2, 2018, the entire disclosure of which is incorporated herein byreference.

BACKGROUND OF THE INVENTION Field of the Invention

The present invention relates to systems and methods for treating thestructure of the natural human crystalline lens with a laser to addressa variety of medical conditions, such as presbyopia and refractiveerror. In particular, embodiments of the present inventions relate tosystems, methods and laser delivery patterns that improve the opticalsystem of the eye and thus improve vision, provide a perceived orapparent improvement in vision and thus improve vision, and both.

Parlor tricks and optical illusions, creating perceived images in thebrain, and thus apparent images that the individual actually sees, basedon the way in which the brain processes images from the optical systemsof the human eye have been known. For example, placing a small tube ofpaper in front of one eye and then your hand in front of the other eye,will create a perceived or apparent image of your hand with a hole init. It is theorized that the brain combines these two images from theeye into one. Similarly, the use of mirror therapy for amputees uses aperceived image to affect the brain's function, thus the body'sfunction. Mirror therapy is a form of motor imagery in which a mirror isused to convey visual stimuli to the brain through observation of one'sunaffected body part as it carries out a set of movements. Theunderlying principle is that movement of the affected limb can bestimulated via visual cues originating from the opposite side of thebody, but which when viewed as a mirror image, are perceived as beingthe afflicted limb. Hence, it is thought that this form of therapy canprove useful in patients who have lost movement of an arm or legincluding those who have had a stroke, as well as, in relieving phantompain.

In the present field of the inventions—ophthalmology, and laser systemsto improve vision and threat conditions of the human eye—the techniquesof “tricking” the brain into seeing better, have found limitedapplication. One common utilization of this is what can be calledmono-vision, where a user has two different contacts, or lasercorrections, one for distance and one for near vision. The brain inabout ⅓ of patients will readily combine and adjust the images, givingthe patient the ability to see both near and far images.

The anatomical structures of the eye are shown in general in FIG. 8,which is a cross sectional view of the eye. The sclera 131 is the whitetissue that surrounds the lens 103 except at the cornea 101. The cornea101 is the transparent tissue that comprises the exterior surface of theeye through which light first enters the eye. The iris 102 is a colored,contractible membrane that controls the amount of light entering the eyeby changing the size of the circular aperture at its center (the pupil).The ocular or natural crystalline lens 103, a more detailed picture ofwhich is shown in FIG. 8A, (utilizing similar reference numbers forsimilar structures) is located just posterior to the iris 102. The termsocular lens, natural crystalline lens, natural lens, natural humancrystalline lens, and lens (when referring to the prior terms) are usedinterchangeably herein and refer to the same anatomical structure of thehuman eye.

Generally, the ocular lens changes shape through the action of theciliary muscle 108 to allow for focusing of a visual image. A neuralfeedback mechanism from the brain allows the ciliary muscle 108, actingthrough the attachment of the zonules 111, to change the shape of theocular lens. Generally, sight occurs when light enters the eye throughthe cornea 101 and pupil, then proceeds through the ocular lens 103through the vitreous 110 along the visual axis 104, strikes the retina105 at the back of the eye, forming an image at the macula 106 that istransferred by the optic nerve 107 to the brain. The space between thecornea 101 and the retina 105 is filled with a liquid called the aqueous117 in the anterior chamber 109 and the vitreous 110, a gel-like clearsubstance, in the chamber posterior to the lens.

FIG. 8A illustrates, in general, components of and related to the lens103 for a typical 50-year old individual. The lens 103 is amulti-structural system. The lens 103 structure includes a cortex 113,and a nucleus 129, and a lens capsule 114. The capsule 114 is an outermembrane that envelopes the other interior structures of the lens. Thelens epithelium 123 forms at the lens equatorial 121 generatingribbon-like cells or fibrils that grow anteriorly and posteriorly aroundthe ocular lens. The nucleus 129 is formed from successive additions ofthe cortex 113 to the nuclear regions. The continuum of layers in thelens, including the nucleus 129, can be characterized into severallayers, nuclei or nuclear regions. These layers include an embryonicnucleus 122, a fetal nucleus 130, both of which develop in the womb, aninfantile nucleus 124, which develops from birth through four years foran average of about three years, an adolescent nucleus 126, whichdevelops from about four years until puberty which averages about 12years, and the adult nucleus 128, which develops at about 18 years andbeyond.

The embryonic nucleus 122 is about 0.5 mm in equatorial diameter (width)and 0.425 mm in Anterior-Posterior axis 104 (AP axis) diameter(thickness). The fetal nucleus 130 is about 6.0 mm in equatorialdiameter and 3.0 mm in AP axis 104 diameter. The infantile nucleus 124is about 7.2 mm in equatorial diameter and 3.6 mm in AP axis 104diameter. The adolescent nucleus 126 is about 9.0 mm in equatorialdiameter and 4.5 mm in AP axis 104 diameter. The adult nucleus 128 atabout age 36 is about 9.6 mm in equatorial diameter and 4.8 mm in APaxis 104 diameter. These are all average values for a typical adulthuman lens approximately age 50 in the accommodated state, ex vivo. Thusthis lens (nucleus and cortex) is about 9.8 mm in equatorial diameterand 4.9 mm in AP axis 104 diameter. Thus, the structure of the lens islayered or nested, with the oldest layers and oldest cells towards thecenter.

The lens is a biconvex shape as shown in FIGS. 8 and 8A. The anteriorand posterior sides of the lens have different curvatures and the cortexand the different nuclei in general follow those curvatures. Thus, thelens can be viewed as essentially a stratified structure that isasymmetrical along the equatorial axis and consisting of long crescentfiber cells arranged end to end to form essentially concentric or nestedshells. The ends of these cells align to form suture lines in thecentral and paracentral areas both anteriorly and posteriorly. The oldertissue in both the cortex and nucleus has reduced cellular function,having lost their cell nuclei and other organelles several months aftercell formation.

Compaction of the lens occurs with aging. The number of lens fibers thatgrow each year is relatively constant throughout life. However, the sizeof the lens does not become as large as expected from new fiber growth.The lens grows from birth through age 3, from 6 mm to 7.2 mm or 20%growth in only 3 years. Then the next approximate decade, growth is from7.2 mm to 9 mm or 25%; however, this is over a 3 times longer period of9 years. Over the next approximate 2 decades, from age 12 to age 36 thelens grows from 9 mm to 9.6 mm or 6.7% growth in 24 years, showing adramatically slowing observed growth rate, while we believe there is arelatively constant rate of fiber growth during this period. Finally, inthe last approximately 2 decades described, from age 36 to age 54, thelens grows by a tiny fraction of its youthful growth, from 9.6 to 9.8 mmor 2.1% in 18 years. Although there is a geometry effect of needing morelens fibers to fill larger outer shells, the size of the older lens isconsiderably smaller than predicted by fiber growth rate models, whichconsider geometry effects. Fiber compaction including nuclear fibercompaction is thought to explain these observations.

In general, presbyopia is the loss of accommodative amplitude. Ingeneral, refractive error is typically due to variations in the axiallength of the eye. Myopia is when the eye is too long resulting in thefocus falling in front of the retina. Hyperopia is when the eye is tooshort resulting in the focus falling behind the retina. In general,cataracts are areas of opacification of the ocular lens which aresufficient to interfere with vision.

Presbyopia most often presents as a near vision deficiency, theinability to read small print, especially in dim lighting after about40-45 years of age. Presbyopia, or the loss of accommodative amplitudewith age, relates to the eyes inability to change the shape of thenatural crystalline lens, which allows a person to change focus betweenfar and near, and occurs in essentially 100% of the population.Accommodative amplitude has been shown to decline with age steadilythrough the fifth decade of life.

As used herein unless specified otherwise, the recitation of ranges ofvalues herein is merely intended to serve as a shorthand method ofreferring individually to each separate value falling within the range.Unless otherwise indicated herein, each individual value within a rangeis incorporated into the specification as if it were individuallyrecited herein.

Generally, the term “about” as used herein unless stated otherwise ismeant to encompass a variance or range of ±10%, the experimental orinstrument error associated with obtaining the stated value, andpreferably the larger of these.

This Background of the Invention section is intended to introducevarious aspects of the art, which may be associated with embodiments ofthe present inventions. Thus the forgoing discussion in this sectionprovides a framework for better understanding the present inventions,and is not to be viewed as an admission of prior art.

SUMMARY

There has existed a long standing and unfulfilled need to addresspresbyopia, replace the need for bifocals, and restore the ability tosimultaneously have good near and far vision in older and presbyopicpatients. The present inventions, among other things, solve these andother needs by providing the articles of manufacture, devices andprocesses set forth in this specification, drawings and claims.

Thus, there is provided a laser system for performing a laser operationto increase the amplitude of accommodation of an eye, the laser systemhaving: a laser for generating a laser beam; a control system, thecontrol system having a laser beam delivery pattern and configured todeliver the laser beam to a lens of an eye in the laser deliverypattern; and, the laser beam delivery pattern having an annular ring,located below the lens capsule and entirely within the lens; wherein thelaser beam delivery pattern avoids contact with an AP pillar of lensmaterial and an equatorial pillar of lens material; whereby afterdelivery of the laser beam pattern an AP pillar and an equatorial pillarof laser unaffected lens material remains; whereby after delivery of thelaser beam pattern an annular shape changing zone is created within thelens and extends to and includes the lens capsule.

There is further provided these systems and methods having one or moreof the following features: wherein the laser beam delivery pattern has asecond annular ring; wherein the laser beam delivery pattern has asecond annular ring; wherein the annular rings follow a shape of thelens capsule, and wherein the annular rings do not contact an equatorialaxis of the lens; wherein the laser beam delivery pattern has aplurality of shots having a predetermined power density at the lenscapsule and within the lens; and wherein the AP pillar has a crosssectional diameter of about 1 mm to about 2 mm; wherein the laser beamdelivery pattern has a plurality of shots, wherein the laser shots havea pulse length, and a spot size at the focal point; and wherein the APpillar defines an axis; and the AP pillar axis is coaxial with an APaxis of the eye; wherein the laser beam delivery pattern has a pluralityof shots, wherein the laser shots have a pulse length, and a spot sizeat the focal point; and wherein the AP pillar defines an axis; and theAP pillar axis is not coaxial with an AP axis of the eye; wherein the APpillar defines an axis; and the AP pillar axis is not coaxial and istitled with an AP axis of the eye; wherein the laser beam deliverypattern has a second annular ring; and wherein the AP pillar defines anaxis; and the AP pillar axis is not coaxial with an AP axis of the eye;and, wherein the laser beam delivery pattern has a second annular ring;wherein the annular rings follow a shape of the lens capsule, andwherein the annular rings do not contact an equatorial axis of the lens;and wherein the AP pillar defines an axis; and the AP pillar axis is notcoaxial and is titled with an AP axis of the eye.

Yet further there is provided a laser system for performing a laseroperation to increase the amplitude of accommodation of an eye, thelaser system having: a laser for generating a laser beam; a controlsystem, the control system having a laser beam delivery pattern andconfigured to deliver the laser beam to a lens of an eye in the laserdelivery pattern; and, the laser beam delivery pattern having an annularring, located below the lens capsule and entirely within the lens;wherein the laser beam delivery pattern avoids contact with an AP pillarof lens material and an equatorial pillar of lens material; wherebyafter delivery of the laser beam pattern an AP pillar and an equatorialpillar of laser unaffected lens material remains; whereby after deliveryof the laser beam pattern an annular shape changing zone is createdwithin the lens and extends to and includes the lens capsule; wherebythe annular ring defines a volume of lens material of about 4.0 mm³ toabout 75 mm³; and a surface area to volume ratio of about 2 to about 5.

Still further there is provided these systems and methods having one ormore of the following features: wherein the volume is from about 20 mm³to about 40 mm³; wherein the surface area to volume ratio is about 3 toabout 4; and wherein all of the laser beams in the laser beam shotpattern are below LIOB at the lens capsule.

Additionally, there is provided a method of creating structures withinin the lens of an eye, the method having: delivering a laser beam in alaser beam delivery pattern to the lens of an eye; the laser beamdelivery pattern having an annular ring, located below the lens capsuleand entirely within the lens; wherein the laser beam delivery patternavoids contact with an AP pillar of lens material and an equatorialpillar of lens material; wherein the laser beam is below LIOB at thelens capsule, whereby the lens capsule is not cut; the laser beamcreating structures in the lens having an AP pillar, an equatorialpillar, and an annular shape changing zone having laser affected lensmaterial and the lens capsule.

Still further there is provided these systems and methods having one ormore of the following features: wherein the structures provide anincrease in the effective depth of focus that is greater than the depthof focus based upon wave front analysis; wherein the increase is atleast 1 diopter; wherein the increase is at least 2 diopters; whereinthe increase is at least 3 diopters; wherein the annular shape changingzone defines a volume lens material of about 4.0 mm³ to about 75 mm³;wherein the annular shape changing zone defines a surface area to volumeratio of about 2 to about 5; wherein the annular shape changing zonedefines a volume lens material of about 4.0 mm³ to about 75 mm³; and asurface area to volume ratio of about 2 to about 5; wherein the laserbeam is below LIOB within 0.05 mm of the lens capsule; wherein the laserbeam is below LIOB within 0.25 mm of the lens capsule; and wherein thelaser beam is below LIOB within 0.5 mm of the lens capsule.

Moreover there is provided a method of enhancing vision with a laserbeam delivery system, the method having: delivering a laser beam to aneye of a patient in a laser beam pattern from a laser beam laser beamdelivery system; the eye having a lens having a lens and zonules; thelens having a lens capsule and lens material within the lens capsule;the eye having a first amplitude of accommodation; delivering the laserbeam to the lens of the eye without cutting damaging, or weakening thelens capsule; and without cutting, damaging or weakening an AP pillarand an equatorial pillar of the lens material; wherein the laser beamforms a shape changing zone; whereby upon action of the zonules, theshape changing zone moves from a first shape to a second shapeincreasing the first amplitude of accommodation to a second amplitude ofaccommodation.

Still further there is provided these systems and methods having one ormore of the following features: wherein the second amplitude ofaccommodation is from 0.05 diopters to 5 diopters; wherein the secondamplitude of accommodation is from 1 diopter to 5 diopters; wherein thesecond amplitude of accommodation is greater than 2 diopters; whereinthe second shape is concave; wherein the second shape essentiallyfollows the shape of the lens; wherein the laser beam is below LIOB inthe lens capsule; and wherein the laser beam never exceeds LIOB in thelens capsule, the AP pillar and the equatorial pillar.

Further there is provided a method of enhancing the vision of a patient,using a laser beam delivery system, the method having: positioning apatient with respect to a laser beam delivery system; the patient havingin an eye; having a lens having a lens capsule and lens material withinthe lens capsule; delivering the laser beam to the lens of the eyewithout cutting damaging, or weakening the lens capsule; and withoutcutting, damaging or weakening an AP pillar and an equatorial pillar ofthe lens material; wherein the laser beam forms a shape changing zone;the shape changing zone capable of movement from a first shape to asecond shape, thereby providing an amplitude of accommodation.

Still further there is provided these systems and methods having one ormore of the following features: wherein the laser beam does not exceedLIOB in the lens capsule; wherein the laser beam does not exceed LIOB inthe lens capsule and the AP pillar; wherein the laser beam does notexceed LIOB in the lens capsule, the AP pillar and the equatorialpillar; wherein the laser beam delivery pattern has a second annularring; wherein the laser beam delivery pattern has a second annular ring;wherein the annular rings follow a shape of the lens capsule, andwherein the annular rings do not contact an equatorial axis of the lens;wherein the AP pillar has a cross sectional diameter of about 1 mm toabout 2 mm; wherein the AP pillar defines an axis; and the AP pillaraxis is coaxial with an AP axis of the eye; wherein the AP pillardefines an axis; and the AP pillar axis is not coaxial with an AP axisof the eye; wherein the AP pillar defines an axis; and the AP pillaraxis is not coaxial and is titled with an AP axis of the eye; whereinthe laser beam delivery pattern has a second annular ring; and whereinthe AP pillar defines an axis; and the AP pillar axis is not coaxialwith an AP axis of the eye; and, wherein the laser beam delivery patternhas a second annular ring; wherein the annular rings follow a shape ofthe lens capsule, and wherein the annular rings do not contact anequatorial axis of the lens; and wherein the AP pillar defines an axis;and the AP pillar axis is not coaxial and is titled with an AP axis ofthe eye.

BRIEF DESCRIPTION OF THE DRAWINGS

FIGS. 1A to 1D are cross sectional schematics of an embodiment of alaser process and laser patterns in accordance with the presentinventions.

FIG. 1E is a perspective schematic of an embodiment of an unaffectedsection of a lens of an eye in accordance with the present inventions.

FIG. 2A to 2B are cross sectional schematics of an embodiment of a laserprocess and laser patterns in accordance with the present inventions.

FIG. 3 is a cross sectional schematic of an embodiment of an AP pillarand equatorial pillar, in a lens of an eye, in accordance with thepresent inventions.

FIG. 4 is a cross sectional schematic of an AP pillar and equatorialpillar, in a lens of an eye, in accordance with the present inventions.

FIGS. 5A and 5C are cross sectional and perspective views, respectively,of an embodiment of a laser shot pattern in accordance with the presentinvention.

FIGS. 5B and 5D are cross sectional and perspective views, respectively,of an embodiment of a laser shot pattern in accordance with the presentinventions.

FIG. 6 is schematic view of an embodiment of a laser system inaccordance with the present invention.

FIG. 7 shows a schematic of an embodiment of a networked laser system inaccordance with the present inventions.

FIGS. 8 and 8A are cross sectional representations of the human eye.

FIG. 9 is a perspective view of an embodiment of an off-axis laser shotpattern in accordance with the present inventions.

FIG. 10 is a cross sectional view of the laser shot pattern of FIG.

FIG. 11 is a perspective, partial cutaway view, of an embodiment of alaser shot pattern in the lens of the eye, in accordance with thepresent inventions.

FIG. 12 is a chart showing near add refractive power for an embodimentof a laser operation using an embodiment of a laser shot pattern inaccordance with the present inventions.

FIG. 13 is a chart showing increase of the negative spherical aberrationfor an embodiment of a laser operation using an embodiment of a lasershot pattern in accordance with the present inventions.

FIG. 14 is a chart showing defocus curves before and after lasertreatment using embodiments of laser operations in accordance with thepresent inventions.

DESCRIPTION OF THE PREFERRED EMBODIMENTS

In general, embodiments of the present inventions provide systems andmethods for addressing conditions of the natural crystalline lens of theeye, and in particular for delivering laser beam patterns to the eye toaddress, mitigate and reverse these conditions.

In general, embodiments of the present inventions relate to systems,methods and laser delivery patterns, contained within and provided bythose systems, that when delivered to the lens of the eye will improvethe optical system of the eye, and thus improve vision, provide aperceived or apparent improvement in vision and thus improve vision, andboth. In particular, embodiments of the systems and the laser patternsthat they provide, change the internal structure of the lens, causingforces acting on, within or both, the lens to change the shape of thelens to provide, or improve, the patient's vision with greateraccommodation. Thus, the actual, apparent or perceived, and bothamplitude of accommodation of the patient is greatly improved, havingthe ability to perceive 2-7 diopters, 3-5 diopters, 3 diopters, 4diopters, 5 diopters, 6 diopters and more amplitude of accommodation,greater lesser amounts and amounts within these ranges are contemplated.Thus, using Hofstetter's average amplitude of accommodation formulabased on age (amplitude of accommodation=18.5−(0.3*age in years))embodiments of the present laser systems can return the vision of a55-year old to the vision of a 50-year old, the vision of a 45-year old,the vision of a 40-year old, the vision of a 35-year old and younger.Thus, these systems and methods have the ability to in effectivereverse, and reverse, the effects of presbyopia by 5 to 25 years, 5years or more, 10 years or more, 15 years or more, and 20 years or more.

Turning to FIG. 1A to 1D there is provided a cross section of a lensthat has an embodiment of a laser pattern delivered to the lens todefine an embodiment of an internal structure. These figures thenillustrate the delivery of the laser pattern, and its effects on theamplitude of accommodation of the lens. Thus, in FIG. 1A there isprovided a lens 3000 having an AP axis 3001 and an equatorial axis 3002.In FIG. 1B a laser treatment pattern 3300 is delivered to the lens,which does not shoot a center area along the AP axis 3001, which definesan AP pillar structure 3003 (a pillar of material along and surroundingthe AP axis where the laser beam is not delivered, does not ablate orremove material, does not affect the structural and optical propertiesof the AP pillar, and preferably all of these). The laser treatmentpattern 3300 also does not shoot a center area along the equatorial axis3002, which defines an equatorial pillar structure 3004, which given theshape of the lens is disk shaped. The laser treatment pattern weakensthe lens material near the surface, and preferably below the surface ofthe lens capsule to a point adjacent the pillars 3003, 3004.

Turning to FIG. 1C shows the laser treated lens, and internal pillarstructures 3003, 3004 when the lens is in an accommodated state 3000 a.Thus, the accommodated lens 3000 a has indentations or depressions(which would be annular in this embodiment), one indentation 3005forming in the anterior side, and the other indentation 3009 forming inthe posterior side. Turning to FIG. 1D, when the lens is in adisaccommodated state 3000 b, the zonules are exerting forces on theeye, generally depicted as arrows 3007. Thus, the indentations flattenout as taut annular areas 3006, 3008. Thus, comparing the shape of theaccommodated lens 3000 a to the disaccommodated lens 3000 b, the changein the lens providing of increased accommodative amplitude (over theuntreated lens) is illustrated.

Turning to FIG. 1E, there is shown the internal support structure 3020,in isolation from the lens, for illustration purposes (noting that thisinternal structure in practice would not be removed from the lens). Theinternal support structure has the AP pillar 3003 and the equatorialpillar 3004, which form the integral internal support structure 3020.

In the embodiment of FIG. 1 A-D, the internal support structure has endsthat extend out to and contact or include the lens capsule. The internalsupport structure is shown (in isolation from the lens material for thepurposes of illustration in FIG. 1E). Thus, the AP pillar 3003 wouldhave an anterior end at the anterior lens capsule and a posterior end atthe posterior lens capsule. Similarly, in this embodiment, theequatorial pillar 3004, which although called a pillar, is a disc shape,would have an end along the equator of the lens capsule. Thus, it can beseen that the regions of accommodation, e.g., 3005-3006, and 3009-3008,are located between the ends of the pillars.

To further illustrate the mechanical theory believed to be occurring inthe lens treated to provide for internal support structures one can turnto FIGS. 2A and 2B. FIG. 2A is a schematic cross section of a portion ofa lens 3100 in an accommodated state 3100 a, having an indent 3105. (Asdiscussed in further detail below, the indent 3105 corresponds to, oris, a shape changing zone that is formed by the delivery of the laserpattern and the pillars.) FIG. 2B is a schematic cross section of aportion of the lens 3100 in a disaccommodated state 3100 b, having tautsection 3106. The AP axis 3101 and a portion of the equatorial axis 3102are shown for reference. To further explain the operation of theaccommodation of the lens one can envision a beam 3103 in the lens 3100.As the zonules exert a force the beam is moved from its first position3103 a (accommodated) to its second position 3103 b (disaccommodated).In moving from the first position 3103 a to the second 3103 b the lenscapsule is drawn tight, creating the taut area 3016, where the indent3105 had been.

During accommodation, in embodiments, the beam 3103 can have a change ofabout 5° in angle, about 10° in angle, about 20° in angle, about 30° inangle, about 40° in angle, about 50° in angle, about 45°, from 5° toabout 50° change in angle, about 15° to about 40° change in angle, andlarger and smaller changes as well as changes within these ranges.

Further, the present internal support structure based accommodation,provides the advantage that only a small amount of lens material has tomove in order for their to be effective accommodation (e.g., the patientcan notice the difference in focus, reading etc.). When accommodation isrestored through changing large areas of the lens, and in particularareas along the AP axis, so that accommodation occurs by changing theentire shape of the lens along the AP axis (i.e., the whole lensflattens out, or increases in height), a large amount of lens material(in general substantially larger than with the use of internal supportstructures) must be moved to have an effective accommodation. Themovement of a smaller amount (e.g., mass, volume and both) of lensmaterials enables faster accommodation.

Thus, after delivery of embodiments of the laser beam pattern, and theformation of embodiments of the axial and equatorial pillars, the volumeof lens material that changes shape during accommodation is from about10% to about 80%, from about 10% to about 50%, from about 5% to about30%, from about 10% to about 40%, from about 5% to about 25%, less than50%, less than 40%, less than 30%, and less than 20%. This volume ofmaterial that is treated by the laser shot pattern, and that changesshape during accommodation, is referred to as the “laser effectedaccommodation volume” of lens material, or for the area that changesshape, the “laser effected accommodation area” of lens tissue.

An embodiment of a laser delivery pattern for delivering a laser beamsto the lens of the eye is shown in FIG. 3. The lens 300 has a laserdelivery pattern delivered to the lens, leaving an AP pillar 301 thatextends from the anterior lens capsule 306 to the posterior lens capsule307, has a circular cross section with a diameter shown by arrow 302 (Inthese figures, it is noted that this diameter is the actual diameter ofthe pillar, i.e., normal to the pillar's axis; and not at some angle. Itis noted that the arrows in these figures is only by way ofillustration). The diameter can be from about 1 mm to about 3 mm, fromabout 1 mm to about 5 mm, and preferably the diameter is 2 mm, andpreferably the center axis of the pillar 302 is coaxial with the AP axisof the lens. It being understood that the pillar axis can be off axiswith the AP axis, that the pillar can have a varying diameter, and thatthe pillar cross section can be shapes other than circular, such assquare, rectangular, bowling pin, and elliptical.

The equatorial pillar 303 is disc shaped and has a thickness 304 that isgreater near the lens capsule 305, and thinner 310, where the pillar 303joints the AP pillar 301. It being understood that in other embodimentsthe equatorial pillar can have a uniform thickness or have a greaterthickness at the lens capsule; and vice versa. In the embodiment of FIG.3, the equatorial pillar 303 has an axis that is on, coincident orco-planar with the equatorial axis (or central plane) of the lens. Inembodiments the axis of the equatorial pillar can be above or below thecenter equatorial axis of the lens. The equatorial pillar can havethickness of from about 0.25 mm to about 2 mm, about 0.75 mm to about 3mm, 0.25 mm to about 4 mm, more than ⅓ of the lens, all values withinthese ranges, and preferably about from 0.5 mm to 1 mm. Preferably theequatorial pillar is coincident with the lens equatorial axis. Inembodiments, the equatorial pillar could also be placed anterior orposterior to the equatorial axis, or in the plane passing through halflens thickness.

Embodiments of the annular laser beam delivery patterns have a width(the distance from the inner edge of the ring, near the AP pillar, toouter edge of the ring near lens capsule) from about 1.5 mm to 3.5 mm,about 2.0 mm to about 3.0 mm, about 3 mm, about 2.5 mm, about 2 mm,about 2.0 mm to 2.9 mm, about 1 mm to about 4 mm, and greater andsmaller widths, as well as, all widths within these ranges. The ring canhave a maximum thickness (recognizing that in embodiments of the ring itmay be uniform, thicker near the center of the ring's width, or thickerat one or both edges of the ring), which is from about 0.2 mm to about1.5 mm, about 0.3 mm to about 1.0 mm, and greater and smaller maximumthickness, as well as, values within these ranges.

The volume of the laser beam delivery pattern can be from about 4.0 mm³to about 75 mm³, about 10 mm³ to about 50 mm³, about 20 mm³ to about 40mm³, about 25 mm³, about 30 mm³, about 40 mm³ and about 50 mm³ andgreater and smaller areas, as well as, areas within these ranges. Thelaser beam delivery pattern can have a surface area to volume ratio(“sa/vol”) of from about 2 to about 5, about 2.5, about 3, about 3.5,about 4, and about 4.5 mm³ and greater and smaller sa/vol, as well as,sa/vol within these ranges. It being understood that when the laser beamdelivery pattern has two annular rings, e.g., one above and one belowthe equatorial axis, the total volume will be the sum of each zone. Thelens material that this struck by the laser beam pattern, will generallycorrespond with the volume of the laser beam delivery pattern.

In preferred embodiments, the lens material of the AP and equatorialpillars are not weakened, cut, or ablated by the laser beam deliverypattern. In preferred embodiments, the laser beam delivery pattern isnot delivered into the pillars. The pillars are formed by, or can beviewed as the remaining material after delivery of the laser beampattern that is not changed by the laser beam, and is structurallystronger than the laser treated material. The pillars essentially retainthe original strength and other properties of the lens material, beforedelivery of the laser beam to the lens.

Turning to the embodiment of FIG. 4, the equatorial pillar is thinnerthan that of the embodiment of FIG. 3 and is above the equatorial axisfor the lens.

Turning to FIGS. 5A and 5C there is shown a cross sectional andperspective view of an embodiment of a laser beam delivery pattern 500.The laser beam delivery pattern 500 has uniform laser shots that formtwo discs, an upper 500 a and a lower 500 b. The pattern 500 follows,i.e., has the same shape as, the lens capsule 520. In this embodiment,the AP pillar would have a uniform diameter, and be circular. Theequatorial pillar would be disc shaped, extending out from the AP pillarby 3 mm (−1 to −3 and 1 to 3 as shown on the x axis of the FIG. 5A). Thesurface of the equatorial pillar would have the same shape, i.e., thesame curvature, as the lens. This laser delivery pattern would alsoprovide for a third pillar, which would be a thickened ring that extendsaround, or on top of and below the equatorial pillar, generally in thearea 510 of the lens.

Turning to FIGS. 5B and 5D there is shown a cross sectional andperspective view of an embodiment of a laser beam delivery pattern 501.The laser beam delivery pattern has grid like shots that form two discs,an upper disc pattern 501 a and a lower disc pattern 501 b. In thisembodiment, the pattern is made up of intersecting planes that form an“ice cube tray” like pattern, it being recognized that other patternsand arrangements of shots in a particular shot pattern can be used. Theupper and lower curves of the pattern follow, i.e., has the same shapeas, the lens capsule. In this embodiment, the AP pillar would have auniform diameter, and be circular. The equatorial pillar would be discshaped, extending out from the AP pillar by 3 mm (−1 to −3 and 1 to 3 asshown on the x axis of the FIG. 55). The surfaces (top and bottom) ofthe equatorial pillar would be planar, i.e., they are flat, not curved,and do not follow the curvature of the lens. This laser delivery patternwould also provide for a third pillar, which would be a thickened ringthat extends around, or on top of and below the equatorial pillar,generally in the area 511 of the lens.

FIG. 9 is a perspective view of an off-axis laser beam delivery pattern1001, which will provide an off-axis AP pillar 1101 and an off-axisequatorial pillar 1102. FIG. 10 is a cross section of the pattern ofFIG. 9. FIG. 10 shows the off axis pattern 1001 with respect to the APaxis 1002, the equatorial axis 1003 and the lens capsule 1004.

In embodiments, the AP pillar can be off axis with the AP axis, theequatorial pillar can be off axis with the equatorial axis and both.

Thus, in embodiments of the present inventions, the delivery of thelaser beam to the lens in embodiments of the laser beam patterns create,through leaving unaffected by the laser beam, the AP pillar and theequatorial pillars, these pillars in conjunction with the annular areasthat have changing shape by the force of the zonules. These areas ofchanging shape are annular rings that go around the AP pillar and can beon the anterior side of the lens, the posterior side of the lens andpreferably both sides of the lens. These areas of changing shape cantransition from: (i) the curvature of the lens (pre-treatment), to (ii)essentially the same as the curvature of the lens (i.e., arcs of thecurves are within at least 90% of each other), to (iii) straight, to(iv) concave. This transition is repeatable, can be performed forward(i) to (iv) and backward (iv) to (i), as well as combination of these,for example (ii) to (iii) to (i) to (iv) to (i).

The annular areas of changing shape have a width (the distance from theinner edge of the ring, near the AP pillar, to outer edge of the ringnear lens capsule) from about 1.5 mm to 3.5 mm, about 2.0 mm to about3.0 mm, about 3 mm, about 2.5 mm, about 2 mm, about 2.0 mm to 2.9 mm,and greater and smaller widths, as well as, widths within these ranges.The ring can have a maximum thickness (recognizing that in embodimentsof the ring it may be uniform, thicker near the center of the ring'swidth, or thicker at one or both edges of the ring), which is from about0.2 mm to about 1.5 mm, about 0.3 mm to about 1.0 mm, and greater andsmaller maximum thickness, as well as, values within these ranges.

The volume of the annular area of changing shape, i.e. the “shapechanging zone”, can be from about 4.0 mm³ to about 75 mm³, about 10 mm³to about 50 mm³, about 20 mm³ to about 40 mm³, about 25 mm³, about 30mm³, about 40 mm³ and about 50 mm³ and greater and smaller areas, aswell as, areas within these ranges. The shape changing zone can have asurface area to volume ratio (“sa/vol”) of from about 2 to about 5,about 2.5, about 3, about 3.5, about 4, and about 4.5 mm³ and greaterand smaller sa/vol, as well as, sa/vol within these ranges. It beingunderstood that when there are two shape changing zones, e.g., one aboveand one below the equatorial axis, the total volume will be the sum ofeach zone.

These volumes and sa/vol for the shape changing zone permit very rapidaccommodation rate, i.e, the shape can be changed very quickly, anaccommodation rate that is equal to an eye having no presbyopia (e.g.,14-20 year old eye), and rates equal to or superior to accommodatingIOLs.

In preferred embodiments the delivery of the laser pattern is entirelywithin the lens, and passes through, and does not otherwise effect, cutor damage the lens capsule. Thus, the creation of the shape changingzone occurs without changing, e.g., damaging, cutting, the lens capsulewith the laser. It being understood that the lens capsule is a part ofthe shape changing zone, and as such the shape changing zone has bothlaser affected and laser unaffected materials.

In embodiments, the accommodation that is provided from embodiments ofapplication of the present patterns and laser treatments, can be totallya brain function, in which case there is no material in the lens that isactually moving. In this embodiment accommodation is exceeding fast, andfaster than the rate of accommodation in a young eye, e.g., fullyaccommodative eye, where the lens is changing shape. In otherembodiments where the lens shape or surface is dynamically changing,e.g., moving, the rate of accommodation is based primarily on theneurological loop controlling the zonules.

In embodiments of the present inventions delivery of the laser beampatterns and creation of the pillars and shape changing zones providesthe added benefit of changing and increasing the “effective depth offocus” beyond the physical changes to the eye as an optical system. The“effective depth of focus”, as used herein, is the depth of focus thatthe patient sees, as measured by conventional devices and techniques,such as, a refractor and Snellen Eye Chart. (Preferably, as determinedby a licensed professional.)

In embodiments of the present inventions the effective depth of focusincreases from about 0.5 to about 3 diopters, about 0.5 diopters, about1 diopters, about 2 diopters, about 3 diopters, about 3.5 diopters, andgreater and smaller values as well as values within these ranges overthe physical changes to the eye, as an optical system. These increasesare over, e.g., in addition to, the accommodation that the eye as aphysical optical system is capable off based upon optical measuringsystems such as wavefront analysis. Thus, for example, if afterperforming an embodiment of the present laser operations, the patienthas an effective depth of focus of 5 diopters, and wave front analysisof the eye shows an accommodation of 3 diopters, the laser operationwould have obtained a change, (here an increase) in the effective depthof focus of 2 diopters over the eye's optical system.

In this manner it is theorized that one result of embodiments of thepresent laser operations is for the eye to provide images (e.g., imagesignals) to the brain that are processed from the eye in a manner tothat gives enhanced, e.g., better sight, than the optical improvementsto the optical components, e.g., the lens with shape changing zone andpillars, alone could provide.

A further benefit of embodiments of the present inventions is that nohyperopic shift occurs. Thus, an approach that simply “softens” the lensmaterial to restore accommodation would also cause the lens to bestretched radially by the zonular forces, inducing a flattening andconsequential drop in lens optical power; this would manifest as ahyperopic shift in the subjects vision. By using pillars to add radialstructural stability the hyperopic shift is reduced, minimized andpreferably prevented.

FIG. 11 is a partial cutaway perspective view of the lens, showing anembodiment of a shot pattern to provide an AP pillar and an equatorialpillar. The laser shot pattern 1150 is shown in the lens, and withrespect to a cutaway (for purposes of the figure) of the lens capsule1159. The laser pattern 1150 has a series of radial cuts, e.g., 1151 anda series of concentric cuts, e.g., 1152.

Turning to FIG. 12 there is shown a graph of the improvement in dioptersthat are obtained from a pattern of the type of FIG. 11, but without theradial cuts. D is a control. For the bar 2.8 a near add of −0.4 dioptersis obtained. For the bar 3.5 a near add of −1.20 diopters is obtained.These measurements were obtained using wave front analysis.

Turning to FIG. 13 there is shown a graph of the improvement in dioptersthat are obtained from a pattern of the type of FIG. 11 without theradial cuts. In this figure spherical aberration vs refraction is shownand analyzed. D is a control. For the bar 2.8 a spherical aberrationincrease of −0.25 diopters is obtained. For the bar 3.5 a sphericalaberration increase of −0.80 diopters is obtained. These measurementswere obtained using wave front analysis.

In FIG. 14 there is shown a chart of defocus curves before and after thelaser treatment

An embodiment of a laser system, having embodiments of the present laserpatterns, for performing the laser procedures of the present inventionsis generally shown in FIG. 6, where there is provided a system fordelivering a laser beam shot pattern to the lens of an eye comprising: apatient support 201; a laser 202; optics for delivering the laser beam203; a control system for delivering the laser beam to the lens in aparticular pattern 204, which control system 204 is associated withand/or interfaces with the other components of the system as representedby lines 205; a means for determining the position of lens with respectto the laser 206, which means 206 receives an image 211 of the lens ofthe eye; and a laser patient interface 207.

The patient support 201 positions the patient's body 208 and head 209 tointerface with the optics for delivering the laser beam 203.

In general, the laser 202 should provide a beam 210 that is of awavelength that transmits through the cornea, aqueous and lens. The beamshould be of a short pulse width, together with the energy and beamsize, to produce photodisruption. Thus, as used herein, the term lasershot or shot refers to a laser beam pulse delivered to a location thatresults in photodisruption. As used herein, the term photodisruptionessentially refers to the conversion of matter to a gas by the laser. Inparticular, wavelengths of about 300 nm to 2500 nm may be employed.Pulse widths from about 1 femtosecond to 100 picoseconds may beemployed. Energies from about a 1 nanojoule to 1 millijoule may beemployed. The pulse rate (also referred to as pulse repetition frequency(PRF) and pulses per second measured in Hertz) may be from about 1 KHzto several GHz. Generally, lower pulse rates correspond to higher pulseenergy in commercial laser devices. A wide variety of laser types may beused to cause photodisruption of ocular tissues, dependent upon pulsewidth and energy density. Thus, examples of such lasers would include:the Delmar Photonics Inc. Trestles-20, which is a Titanium Sapphire(Ti:Sapphire) oscillator having a wavelength range of 780 to 840 nm,less than a 20 femtosecond pulse width, about 100 MHz PRF, with 2.5nanojoules; the Clark CPA-2161, which is an amplified Ti:Sapphire havinga wavelength of 775 nm, less than a 150 femtosecond pulse width, about 3KHz PRF, with 850 microjoules; the IMRA FCPA (fiber chirped pulseamplification) pjewel D series D-400-HR, which is a Yb:fiberoscillator/amplifier having a wavelength of 1045 nm, less than a 1picosecond pulse width, about 5 MHz PRF, with 100 nanojoules; the LumeraStaccato, which is a Nd:YVO4 having a wavelength of 1064 nm, about 10picosecond pulse width, about 100 KHz PRF, with 100 microjoules; and,the Lumera Rapid, which is a ND:YVO4 having a wavelength of 1064 nm,about 10 picosecond pulse width, and can include one or more amplifiersto achieve approximately 2.5 to 10 watts average power at a PRF ofbetween 25 kHz to 650 kHz and also includes a multi-pulsing capabilitythat can gate two separate 50 MHz pulse trains. and, the IMRA FCPA(fiber chirped pulse amplification) pJewel D series D-400-NC, which is aYb:fiber oscillator/amplifier having a wavelength of 1045 nm, less thana 100 picosecond pulse width, about 200 KHz PRF, with 4 microjoules.Thus, these and other similar lasers may be used as therapeutic lasers.

In general, the optics for delivering the laser beam 203 to the naturallens of the eye should be capable of providing a series of shots to thenatural lens in a precise and predetermined pattern in the x, y and zdimension. The optics should also provide a predetermined beam spot sizeto cause photodisruption with the laser energy reaching the naturallens. Thus, the optics may include, without limitation: an x y scanner;a z focusing device; and, focusing optics. The focusing optics may beconventional focusing optics, and/or flat field optics and/ortelecentric optics, each having corresponding computer controlledfocusing, such that calibration in x, y, z dimensions is achieved. Forexample, an x y scanner may be a pair of closed loop galvanometers withposition detector feedback. Examples of such x y scanners would be theCambridge Technology Inc. Model 6450, the SCANLAB hurrySCAN and theAGRES Rhino Scanner. Examples of such z focusing devices would be thePhsyik International Peizo focus unit Model ESee Z focus control and theSCAN LAB varrioSCAN.

In general, the control system for delivering the laser beam 204 may beany computer, controller, and/or software hardware combination that iscapable of selecting and controlling x y z scanning parameters and laserfiring. These components may typically be associated at least in partwith circuit boards that interface to the x y scanner, the z focusingdevice and/or the laser. The control system may also, but does notnecessarily, have the further capabilities of controlling the othercomponents of the system as well as maintaining data, obtaining data andperforming calculations. Thus, the control system may contain theprograms that direct the laser through one or more laser shot patterns.

In general, the means for determining the position of the lens withrespect to the laser 206 should be capable of determining the relativedistance with respect to the laser and portions of the lens, whichdistance is maintained constant by the patient interface 207. Thus, thiscomponent will provide the ability to determine the position of the lenswith respect to the scanning coordinates in all three dimensions. Thismay be accomplished by several methods and apparatus. For example, x ycentration of the lens may be accomplished by observing the lens througha co-boresighed camera system and display or by using direct view opticsand then manually positioning the patients' eye to a known center. The zposition may then be determined by a range measurement device utilizingoptical triangulation or laser and ccd system, such as the Micro-Epsilonopto NCDT 1401 laser sensor and/or the Aculux Laser Ranger LR2-22. Theuse of a 3-dimensional viewing and measurement apparatus may also beused to determine the x, y and z positions of the lens. For example, theHawk 3 axis non-contact measurement system from Vision Engineering couldbe used to make these determinations. Yet a further example of anapparatus that can be used to determine the position of the lens is a3-dimension measurement apparatus. This apparatus would comprise acamera, which can view a reference and the natural lens, and would alsoinclude a light source to illuminate the natural lens. Such light sourcecould be a structured light source, such as for example a slitillumination designed to generate 3-dimensional information based upongeometry. Further one, two, three, four or more, light sources can bepositioned around the eye and the electronically activated to providemultiple views, planar images, of the eye, and in particular the corneaand the lens, at multiple planar slices that can them be integrated toprovide data for position and location information relative to the lasersystem about those structures.

A further component of the system is the laser patient interface 207.This interface should provide that the x, y, z position between thenatural lens and the laser remains fixed during the procedure, whichincludes both the measurement steps of determining the x y z positionand the delivery step of delivering the laser to the lens in a shotpattern. The interface device may contain an optically transparentapplanator. One example of this interface is a suction ring applanatorthat is fixed against the outer surface of the eye and is thenpositioned against the laser optical housing, thus fixing the distancebetween the laser, the eye and the natural lens. Reference marks for the3-dimensional viewing and measuring apparatus may also be placed on thisapplanator. Moreover, the interface between the lower surface of theapplanator and the cornea may be observable and such observation mayfunction as a reference. A further example of a laser patient interfaceis a device having a lower ring, which has suction capability foraffixing the interface to the eye. The interface further has a flatbottom, which presses against the eye flattening the eye's shape. Thisflat bottom is constructed of material that transmits the laser beam andalso preferably, although not necessarily, transmits optical images ofthe eye within the visible light spectrum. The upper ring has astructure for engaging with the housing for the laser optics and/or somestructure that is of known distance from the laser along the path of thelaser beam and fixed with respect to the laser.

It is preferred that the interface may be a corneal shaped transparentelement whereby the cornea is put into direct contact with the interfaceor contains an interface fluid between. Examples of patient interfacesdevices are disclosed and taught in US Patent Application PublicationNos. 2010/0022994, 2011/0022035 and 2015/0088175, the entire disclosuresof each of which are incorporated herein by reference.

Systems methods and apparatus for performing laser operations on the eyeare disclosed and taught in US patent application Publication Nos.2016/0302971, 2015/0105759, 2014/0378955, and U.S. Pat. Nos. 8,262,646and 8,708,491, the entire disclosures of each of which are incorporatedherein by reference.

An embodiment of a network system for performing the laser procedures ofthe present inventions is provided in FIG. 7. This embodiment is anetwork, wherein the laser surgery system 701 is in communication with aWi-Fi router 702. This may be by either an Ethernet connection 701 a orWi-Fi connection 702 a or both. The router 702 is in turn incommunication with a Cassini Topographer 703, A QNAP server 704, aprinter 705, and an OR Microscope 706. The router is linked to thesedevices along communication pathways 703 a, 704 a, 705 a, and 706 a,respectively. This communication may be done either via a Wi-Ficonnection, Ethernet link, other automation or data communicationsystems and combinations and variations of these. Data may be exchangedbetween the laser 701 and the Cassini Topographer 703 and the ORMicroscope 706 via the use of USB Memory Sticks 707 or flash drive 708.This network may optionally include other devices useful in a hospitalor a medical office, including personal computers or mobile devices. Thenetwork may download and/or upload a patient's medical history to aremote server. This information may include previously-acquired dataregarding the patient's iris, and may be used by the system to ensurethat the scanned iris belongs to the patient for whom the currenttreatment plan was developed. Other embodiments of combinations of thedevices in this network are contemplated by the present inventions.

It is noted that there is no requirement to provide or address thetheory underlying the novel and groundbreaking processes, laseroperations, and laser patterns, enhanced and improved vision, or otherbeneficial features and properties that are the subject of, orassociated with, embodiments of the present inventions. Nevertheless,various theories are provided in this specification to further advancethe art in this area. The theories put forth in this specification, andunless expressly stated otherwise, in no way limit, restrict or narrowthe scope of protection to be afforded the claimed inventions. Thesetheories many not be required or practiced to utilize the presentinventions. It is further understood that the present inventions maylead to new, and heretofore unknown theories to explain thefunction-features of embodiments of the methods, laser patterns, laseroperations, functions of the eye, devices and system of the presentinventions; and such later developed theories shall not limit the scopeof protection afforded the present inventions.

The various embodiments of devices, systems, laser shot patterns,activities, and operations set forth in this specification may be usedwith, in or by, various measuring, diagnostic, surgical and therapeuticlaser systems, in addition to those embodiments of the Figures anddisclosed in this specification. The various embodiments of devices,systems, laser shot patterns, activities, and operations set forth inthis specification may be used with: other measuring, diagnostic,surgical and therapeutic systems that may be developed in the future:with existing measuring, diagnostic, surgical and therapeutic lasersystems, which may be modified, in-part, based on the teachings of thisspecification; and with other types of measuring, diagnostic, surgicaland therapeutic systems. Further, the various embodiments of devices,systems, laser shot patterns, activities, and operations set forth inthis specification may be used with each other in different and variouscombinations. Thus, for example, the configurations provided in thevarious embodiments of this specification may be used with each other;and the scope of protection afforded the present inventions should notbe limited to a particular embodiment, configuration or arrangement thatis set forth in a particular embodiment, example, or in an embodiment ina particular Figure.

The inventions may be embodied in other forms than those specificallydisclosed herein without departing from their spirit or essentialcharacteristics. The described embodiments are to be considered in allrespects only as illustrative and not restrictive.

What is claimed:
 1. A laser system for performing a laser operation toincrease the amplitude of accommodation of an eye, the laser systemcomprising: a. a laser for generating a laser beam; b. a control system,the control system comprising a laser beam delivery pattern andconfigured to deliver the laser beam to a lens of an eye in the laserdelivery pattern; and, c. the laser beam delivery pattern comprising anannular ring, located below the lens capsule and entirely within thelens; wherein the laser beam delivery pattern avoids contact with an APpillar of lens material and an equatorial pillar of lens material; i.whereby after delivery of the laser beam pattern an AP pillar and anequatorial pillar of laser unaffected lens material remains; ii. wherebyafter delivery of the laser beam pattern an annular shape changing zoneis created within the lens and extends to and includes the lens capsule.2. The system of claim 1, wherein the laser beam delivery patterncomprises a second annular ring.
 3. The systems of claims 1 and 2,wherein the laser beam delivery pattern comprises a second annular ring;wherein the annular rings follow a shape of the lens capsule, andwherein the annular rings do not contact an equatorial axis of the lens.4. The systems of claims 1, 2, and 3, wherein the laser beam deliverypattern comprises a plurality of shots having a predetermined powerdensity at the lens capsule and within the lens; and wherein the APpillar has a cross sectional diameter of about 1 mm to about 2 mm. 5.The systems of claims 1, 2, 3 and 4, wherein the laser beam deliverypattern comprises a plurality of shots, wherein the laser shots have apulse length, and a spot size at the focal point; and wherein the APpillar defines an axis; and the AP pillar axis is coaxial with an APaxis of the eye.
 6. The systems of claims 1,
 2. 3, and 4, wherein thelaser beam delivery pattern comprises a plurality of shots, wherein thelaser shots have a pulse length, and a spot size at the focal point; andwherein the AP pillar defines an axis; and the AP pillar axis is notcoaxial with an AP axis of the eye.
 7. The systems of claims 1,
 2. 3,and 4, wherein the AP pillar defines an axis; and the AP pillar axis isnot coaxial and is titled with an AP axis of the eye.
 8. The systems ofclaims 1, 2, 3, and 4, wherein the laser beam delivery pattern comprisesa second annular ring; and wherein the AP pillar defines an axis; andthe AP pillar axis is not coaxial with an AP axis of the eye.
 9. Thesystems of claims 1, 2, 3, and 4, wherein the laser beam deliverypattern comprises a second annular ring; wherein the annular ringsfollow a shape of the lens capsule, and wherein the annular rings do notcontact an equatorial axis of the lens; and wherein the AP pillardefines an axis; and the AP pillar axis is not coaxial and is titledwith an AP axis of the eye.
 10. A laser system for performing a laseroperation to increase the amplitude of accommodation of an eye, thelaser system comprising: a. a laser for generating a laser beam; b. acontrol system, the control system comprising a laser beam deliverypattern and configured to deliver the laser beam to a lens of an eye inthe laser delivery pattern; and, c. the laser beam delivery patterncomprising an annular ring, located below the lens capsule and entirelywithin the lens; wherein the laser beam delivery pattern avoids contactwith an AP pillar of lens material and an equatorial pillar of lensmaterial; i. whereby after delivery of the laser beam pattern an APpillar and an equatorial pillar of laser unaffected lens materialremains; ii. whereby after delivery of the laser beam pattern an annularshape changing zone is created within the lens and extends to andincludes the lens capsule; iii. whereby the annular ring defines avolume of lens material of about 4.0 mm³ to about 75 mm³; and a surfacearea to volume ratio of about 2 to about
 5. 11. The system of claim 10,wherein the volume is from about 20 mm³ to about 40 mm³.
 12. The systemof claim 10, wherein the surface area to volume ratio is about 3 toabout
 4. 13. The systems of claims 1 and 10, wherein all of the laserbeams in the laser beam shot pattern are below LIOB at the lens capsule.14. A method of creating structures within in the lens of an eye, themethod comprising: a. delivering a laser beam in a laser beam deliverypattern to the lens of an eye; b. the laser beam delivery patterncomprising an annular ring, located below the lens capsule and entirelywithin the lens; wherein the laser beam delivery pattern avoids contactwith an AP pillar of lens material and an equatorial pillar of lensmaterial; wherein the laser beam is below LIOB at the lens capsule,whereby the lens capsule is not cut; c. the laser beam creatingstructures in the lens comprising an AP pillar, an equatorial pillar,and an annular shape changing zone comprising laser affected lensmaterial and the lens capsule.
 15. The method of claim 14, wherein thestructures provide an increase in the effective depth of focus that isgreater than the depth of focus based upon wave front analysis.
 16. Themethod of claim 14, wherein the increase is at least 1 diopter.
 17. Themethod of claim 14, wherein the increase is at least 2 diopters.
 18. Themethod of claim 14, wherein the increase is at least 3 diopters.
 19. Themethods of claims 14, 15, 16, 17 and 18, wherein the annular shapechanging zone defines a volume lens material of about 4.0 mm³ to about75 mm³.
 20. The methods of claims 14, 15, 16, 17 and 18, wherein theannular shape changing zone defines a surface area to volume ratio ofabout 2 to about
 5. 21. The methods of claims 14, 15, 16, 17 and 18,wherein the annular shape changing zone defines a volume lens materialof about 4.0 mm³ to about 75 mm³; and a surface area to volume ratio ofabout 2 to about
 5. 22. The methods of claims 14, 15, 16, 17 and 18,wherein the laser beam is below LIOB within 0.05 mm of the lens capsule.23. The methods of claims 14, 15, 16, 17 and 18, wherein the laser beamis below LIOB within 0.25 mm of the lens capsule.
 24. The methods ofclaims 14, 15, 16, 17 and 18, wherein the laser beam is below LIOBwithin 0.5 mm of the lens capsule.
 25. A method of enhancing vision witha laser beam delivery system, the method comprising: a. delivering alaser beam to an eye of a patient in a laser beam pattern from a laserbeam laser beam delivery system; b. the eye comprising a lens comprisinga lens and zonules; the lens comprising a lens capsule and lens materialwithin the lens capsule; the eye having a first amplitude ofaccommodation; c. delivering the laser beam to the lens of the eyewithout cutting damaging, or weakening the lens capsule; and withoutcutting, damaging or weakening an AP pillar and an equatorial pillar ofthe lens material; d. wherein the laser beam forms a shape changingzone; e. whereby upon action of the zonules, the shape changing zonemoves from a first shape to a second shape increasing the firstamplitude of accommodation to a second amplitude of accommodation. 26.The method of claim 25, wherein the second amplitude of accommodation isfrom 0.05 diopters to 5 diopters.
 27. The method of claim 25, whereinthe second amplitude of accommodation is from 1 diopter to 5 diopters.28. The method of claim 25, wherein the second amplitude ofaccommodation is greater than 2 diopters.
 29. The method of claim 25,wherein the second shape is concave.
 30. The method of claim 25, whereinthe second shape essentially follows the shape of the lens.
 31. Themethod of claim 25, wherein the laser beam is below LIOB in the lenscapsule.
 32. The method of claim 25, wherein the laser beam neverexceeds LIOB in the lens capsule, the AP pillar and the equatorialpillar.
 33. A method of enhancing the vision of a patient, using a laserbeam delivery system, the method comprising: a. positioning a patientwith respect to a laser beam delivery system; b. the patient having inan eye; comprising a lens comprising a lens capsule and lens materialwithin the lens capsule; c. delivering the laser beam to the lens of theeye without cutting damaging, or weakening the lens capsule; and withoutcutting, damaging or weakening an AP pillar and an equatorial pillar ofthe lens material; d. wherein the laser beam forms a shape changingzone; e. the shape changing zone capable of movement from a first shapeto a second shape, thereby providing an amplitude of accommodation. 34.The method of claim 33, wherein the laser beam does not exceed LIOB inthe lens capsule.
 35. The method of claim 33, wherein the laser beamdoes not exceed LIOB in the lens capsule and the AP pillar.
 36. Themethod of claim 33, wherein the laser beam does not exceed LIOB in thelens capsule, the AP pillar and the equatorial pillar.
 37. The methodsof claims 33, 34, 35 and 36, wherein the laser beam delivery patterncomprises a second annular ring.
 38. The methods of claims 33, 34, 35and 36, wherein the laser beam delivery pattern comprises a secondannular ring; wherein the annular rings follow a shape of the lenscapsule, and wherein the annular rings do not contact an equatorial axisof the lens.
 39. The methods of claims 33, 34, 35 and 36, wherein the APpillar has a cross sectional diameter of about 1 mm to about 2 mm. 40.The methods of claims 33, 34, 35 and 36, wherein the AP pillar definesan axis; and the AP pillar axis is coaxial with an AP axis of the eye.41. The methods of claims 33, 34, 35 and 36, wherein the AP pillardefines an axis; and the AP pillar axis is not coaxial with an AP axisof the eye.
 42. The methods of claims 33, 34, 35 and 36, wherein the APpillar defines an axis; and the AP pillar axis is not coaxial and istitled with an AP axis of the eye.
 43. The methods of claims 33, 34, 35and 36, wherein the laser beam delivery pattern comprises a secondannular ring; and wherein the AP pillar defines an axis; and the APpillar axis is not coaxial with an AP axis of the eye.
 44. The methodsof claims 33, 34, 35 and 36, wherein the laser beam delivery patterncomprises a second annular ring; wherein the annular rings follow ashape of the lens capsule, and wherein the annular rings do not contactan equatorial axis of the lens; and wherein the AP pillar defines anaxis; and the AP pillar axis is not coaxial and is titled with an APaxis of the eye.